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Home News and Update Archives Pregnancy May Delay Diagnosis and Treatment of Breast Cancer

Pregnancy May Delay Diagnosis and Treatment of Breast Cancer

Medscape
09 February 2009
By Karla Gale
New York, USA

Diagnosis and treatment of breast cancer are often delayed when it develops during pregnancy. As a result, long–term survival may be compromised, physicians at the University of Texas M. D. Anderson Cancer Center report in the March 15 issue of Cancer.

The effects of pregnancy on the breast can mask symptoms of breast cancer, making it more difficult to identify, principal investigator Dr. George H. Perkins told Reuters Health.

“The biggest recommendation (to improve early detection) is to be mindful of the bimodal distribution of breast cancer,” he said. “Most clinicians are aware of the increased risk with increasing age but most are not aware of the cancer statistics showing an increase in women with younger age (30–40). Therefore, even though...breast cancer is the most frequent cancer associated with pregnancy, it is low on most differential diagnoses lists.”

Dr. Perkins and his team examined data for 668 operable breast cancers in 652 patients aged 35 and younger, treated at their institution between 1973 and 2006. Fifteen percent of the cancers were pregnancy–associated, defined as breast cancer that develops during (n = 51) or within 1 year after pregnancy (n = 53).

Patients with pregnancy–associated breast cancer had more advanced tumors than their counterparts, indicating delayed diagnosis.

Nevertheless, the authors report, 10–year rates of locoregional recurrence, distant metastases, and overall survival did not differ significantly between pregnancy–associated and non–pregnancy–associated breast cancer.

This counterintuitive finding, Dr. Perkins explained, likely results from broad use of neoadjuvant chemotherapy in their cohort. “The majority of our patients were participants in an early neoadjuvant chemotherapy registry,” he noted, “and as such received treatment after the first trimester and without significant delay in comparison to patients whose treatment was forestalled.”

In a subgroup analysis of the 51 patients who developed breast cancer during pregnancy, 25 received no treatment until after delivery. There was a trend toward worse 10–year survival rates associated with deferred treatment compared with treatment during pregnancy (44.7% vs 78.7%, p = 0.068).

“Neoadjuvant chemotherapy is now the standard of care at our institution for patients with breast cancer during pregnancy,” the oncologist continued. “Our data confirm its safety and efficacy when administered after the completion of the first trimester to allow for the completion of organogenesis in the fetus.”

“Our follow–up studies which are longitudinal and extensive – including psychological assessment of the children – also confirm this approach.”

In addition to timely treatment, the research team also urges more aggressive diagnostic evaluation of breast symptoms during pregnancy, using ultrasound or, with appropriate fetal shielding, mammography.

Their group is working with the National Comprehensive Cancer Network and obstetrics and gynecological associations to “establish benchmarks and develop guidelines for care in this low incidence presentation of disease,” Dr. Perkins said, “which will only increase as the intersection of delayed pregnancies continues with the bimodal curve for breast cancer incidence.”

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